Wearable therapeutic device

ABSTRACT

A wearable monitoring device is provided. The wearable monitoring device includes a garment to hold an electrode, be worn about a subject, and include an orientation circuit. The monitoring device also includes a control unit coupled to the orientation circuit capable of measuring at least one parameter associated with the orientation circuit and determine whether the electrode is positioned in the garment with the conductive surface oriented towards the subject based on the at least one parameter.

CROSS REFERENCE TO RELATED APPLICATION

This application claims the benefit under 35 U.S.C. § 120 as acontinuation of U.S. application Ser. No. 16/257,854, titled “WEARABLETHERAPEUTIC DEVICE,” filed Jan. 25, 2019, which claims the benefit under35 U.S.C. § 120 as a continuation of U.S. application Ser. No.14/630,947, titled “WEARABLE THERAPEUTIC DEVICE,” filed Feb. 25, 2015,now U.S. Pat. No. 10,226,638, which claims the benefit under 35 U.S.C. §120 as a continuation of U.S. application Ser. No. 13/315,894, titled“WEARABLE THERAPEUTIC DEVICE,” filed Dec. 9, 2011, now U.S. Pat. No.9,007,216, which claims priority under 35 U.S.C. § 119(e) to U.S.Provisional Application Ser. No. 61/421,970 titled “WEARABLE THERAPEUTICDEVICE,” filed Dec. 10, 2010 and to U.S. Provisional Application Ser.No. 61/530,585 titled “WEARABLE THERAPEUTIC DEVICE,” filed Sep. 2, 2011,each of which is incorporated herein by reference in its entirety.

BACKGROUND OF THE INVENTION 1. Field of the Invention

At least one embodiment of the present invention relates generally to awearable therapeutic device, and more specifically, to a wearabletherapeutic device having electrodes configured to monitor or treat asubject.

2. Discussion of the Related Art

Cardiac arrest and other health ailments are a major cause of deathworldwide. Various resuscitation efforts aim to maintain the body'scirculatory and respiratory systems during cardiac arrest in an attemptto save the life of the victim. The sooner these resuscitation effortsbegin, the better the victim's chances of survival. Health careprofessionals also attempt to detect and prevent conditions conducive tocardiac ailments by treating patients with drugs or by suggestinglifestyle changes. These efforts are expensive and have a limitedsuccess rate, and cardiac arrest, among other conditions, continues toclaim the lives of victims.

SUMMARY OF THE INVENTION

Aspects and embodiments of the present invention are directed to awearable therapeutic device that is configured to be worn by a subject.The wearable therapeutic device includes at least one electrode in, forexample, a pocket of the wearable therapeutic device. When properlypositioned, a conductive surface of the electrode can be disposed in thepocket to face the subject, proximate to the subject's skin so thatinformation (e.g., cardiac information) can be sensed or treatment(e.g., a defibrillation shock) can be applied to the subject. Aconductive thread can be sewn into parts of the wearable therapeuticdevice, including parts of the pocket that are not proximate to thesubject's skin. A circuit can be formed when the conductive surface ofthe electrode couples with the conductive thread. When this circuit isformed, the conductive surface of the electrode is generally notproximate to the subject's skin, and not in position to apply treatment.Based on the coupling of the conductive surface of the electrode and theconductive thread, an alarm module can indicate that the electrode is oris not properly positioned.

At least one aspect is directed to a wearable therapeutic device. Thewearable therapeutic device includes a garment, and the garment includesan electrode and a conductive thread. A control unit is coupled to theconductive thread and identifies an electrical connection between aconductive surface of the electrode and the conductive thread, and analarm module indicates information about the positioning of theelectrode in the garment based on the electrical connection.

At least one other aspect is directed to a method of facilitating careof a subject. The method provides a wearable therapeutic device thatincludes an electrode and a conductive thread. The method alsoidentifies an electrical connection between a conductive surface of theelectrode and the conductive thread. The method provides a notificationto indicate positioning information of the electrode based on theelectrical connection.

At least one other aspect is directed to and method that includesproviding a wearable therapeutic device including a garment. The garmenthouses an electrode and includes conductive thread. The wearabletherapeutic device includes a control unit coupled to the conductivethread. The control unit identifies an electrical connection between theelectrode and the conductive thread. An alarm module indicatespositioning information of the electrode in the garment based on theelectrical connection.

The electrode can be a therapy electrode or a sensing electrode. In someembodiments, the garment includes a pocket that houses the electrode.The pocket can have a first lateral side and a second lateral side, withthe conductive thread sewn into the first lateral side or into thesecond lateral side. In one embodiment, one lateral side includes aconductive mesh and the other includes the conductive thread. The firstlateral side can be proximate to a subject, and the second lateral sidecan be distal to the subject, with the conductive thread disposed in thesecond lateral side of the pocket.

In one embodiment, a conductive element can be included in the garment.A connector can couple the conductive thread with the conductiveelement. The control unit is further can detect a current path thatincludes the conductive thread, the conductive surface of the electrode,and the conductive element. In one embodiment, the garment includes abelt, with a conductive element included in the belt. A connector cancouple the conductive thread with the conductive element to formelectrical connection between the conductive surface of the electrodeand the conductive element. The connector may include a snap. Theconductive element can connect with the conductive thread at one or morepoints of the conductive thread.

In one embodiment, the conductive thread forms a stitched pattern in thegarment. The conductive thread can also form a stitched patternincluding at least two substantially parallel stitched lines, or apattern in at least one of a quadrilateral shape, a polygonal shape, anoblong shape, a circular shape, an oval shape, a round shape, and atriangular shape. In one embodiment, the conductive thread forms part ofan electrical connection with the electrode.

In one embodiment, the alarm module can notify a subject wearing thewearable therapeutic device, or a health care provider, that theelectrode is properly or improperly positioned. A monitor can display anindication that the electrode is properly or improperly positioned.

In some embodiments, the electrode can be housed in a pocket of thegarment, and the conductive thread can be woven into the pocket. Theelectrode can be determined to be positioned with a conductive surfacefacing away from a subject. A closed circuit that includes a conductivesurface of the electrode and the conductive thread can be detected, andimproper positioning of the electrode can be determined. In oneembodiment, the wearable therapeutic device includes a conductiveelement, and a current path that includes the conductive thread, theconductive surface of the electrode, and the conductive element can bedetected. In one embodiment, the conductive thread can be coupled withthe conductive element.

In one embodiment, instructions can be provided to operate the wearabletherapeutic device. The instructions can include at least oneinstruction directing a subject to position a conductive surface of theelectrode proximate to the subject. The wearable therapeutic device caninclude a garment with a pocket to house the electrode. The pocket canbe formed at least in part from a conductive mesh, and instructions canbe provided to position a conductive surface of the electrode facing theconductive mesh. Instructions can also be provided to position aconductive surface of the electrode facing away from the conductivethread.

Other aspects and embodiments are discussed in detail below. Theforegoing information and the following detailed description includeillustrative examples of various aspects and embodiments, and areintended to provide an overview or framework for understanding thenature and character of the claimed aspects and embodiments. Thedrawings provide illustration and a further understanding of the variousaspects and embodiments, and are incorporated in and constitute a partof this specification. The drawings, together with the remainder of thespecification, serve to describe and explain the claimed aspects andembodiments.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings are not intended to be drawn to scale. In thedrawings, each identical or nearly identical component that isillustrated in various figures is represented by a like numeral. Forpurposes of clarity, not every component may be labeled in everydrawing. In the drawings:

FIG. 1 is a block diagram depicting a wearable therapeutic device inaccordance with an embodiment;

FIG. 2 is a schematic diagram depicting a wearable therapeutic device inaccordance with an embodiment;

FIG. 3 is a diagram depicting a portion of a wearable therapeutic devicewith conductive thread sewn into a pocket in accordance with anembodiment;

FIG. 4 is a diagram depicting a portion of a wearable therapeutic devicewith conductive thread sewn into a pocket in accordance with anembodiment;

FIG. 5 is a diagram depicting a portion of a wearable therapeutic devicewith conductive thread sewn into a pocket in accordance with anembodiment;

FIG. 6 is a cross sectional view of a wearable therapeutic device withan electrode disposed in a pocket of the wearable therapeutic device inaccordance with an embodiment;

FIG. 7 is a cross sectional view of a wearable therapeutic device withan electrode disposed in a pocket of the wearable therapeutic device inaccordance with an embodiment; and

FIG. 8 is a flowchart depicting a method of facilitating care of asubject in accordance with an embodiment.

DETAILED DESCRIPTION

The systems and methods described herein are not limited in theirapplication to the details of construction and the arrangement ofcomponents set forth in the description or illustrated in the drawings.The invention is capable of other embodiments and of being practiced orof being carried out in various ways. Also, the phraseology andterminology used herein is for the purpose of description and should notbe regarded as limiting. The use of “including” “comprising” “having”“containing” “involving” and variations thereof herein, is meant toencompass the items listed thereafter, equivalents thereof, andadditional items, as well as alternate embodiments consisting of theitems listed thereafter exclusively.

Various aspects and embodiments are directed to a wearable therapeuticdevice that can be worn by a subject. The wearable therapeutic devicecan include a garment with at least one pocket to house at least oneelectrode. When the electrode is properly positioned, a conductivesurface of the electrode faces the subject and directly or indirectlycontacts the subject's skin. When properly positioned, the electrode canapply therapy, such as a defibrillation shock, to the subject. Due, forexample, to subject motion or improper installation by the subject, ahealth care provider or manufacturer, the electrode can becomeimproperly positioned, so that its conductive surface does not face thesubject. When the electrode is improperly positioned, its conductivesurface can contact a conductive thread included in the garment. Thiscan form an electrical connection, and detection of this electricalconnection can indicate that the electrode is improperly positioned tosense information about or apply therapy to the subject. An alarm modulecan provide a notification that the electrode is properly or improperlypositioned. Corrective action can be taken to properly position theelectrode.

FIG. 1 is a block diagram of wearable therapeutic device 100 inaccordance with an embodiment. In one embodiment, wearable therapeuticdevice 100 includes the wearable therapeutic device described incommonly owned U.S. patent application Ser. No. 13/109,079, titled“Wearable Therapeutic Device,” filed on May 17, 2011, which isincorporated by reference herein in its entirety. The referencedapplication generally describes a wearable therapeutic device.

Wearable therapeutic device 100 can include at least one garment 105 inthe shape of a vest or shirt. Garment 105 may also include at least onebelt 110. Belt 110 may be worn about a subject's waist, at a higherlocation about or across the subject's chest, or at other locationsbetween the subject's waist and shoulders. Components of wearabletherapeutic device 100, including garment 105, can be worn under, over,or partially under and partially over a subject's clothes. In oneembodiment, garment 105 is formed from breathable fabric. Garment 105may also be stretchable.

In one embodiment, wearable therapeutic device 100 includes at least oneof the following elements: garment 105, belt 110, external defibrillator115, alarm module 120, monitor 125, control unit 130, sensing electrode135, therapy electrode 140, strap 145, conductive thread 150, conductiveelement 155, and pocket 160. In one embodiment, at least one of externaldefibrillator 115, alarm module 120, monitor 125, control unit 130,sensing electrode 135, therapy electrode 140, conductive thread 150,conductive element 155, and pocket 160 are included in or attached togarment 105, belt 110 or strap 145. For example, wearable therapeuticdevice 100 components can be fitted into open or closed pockets 160, orotherwise attached to garment 105 via buckles, hook and loop fasteners,holsters, loops, pouches or sleeves that form part of belt 110 or strap145. These elements may also be integrated into belt 110 or strap 145,and these elements may be a permanent part of belt 110 or strap 145, orreleasable from belt 110 or strap 145. Garment 105 may include a seriesof belts 110 or straps 145, and need not constitute an article ofclothing. Wearable therapeutic device 100 may include one, more thanone, or all of the above mentioned elements, as well as additionalelements such as at least one power supply to provide power to controlunit 130, external defibrillator 115, alarm module 120, monitor 125,sensing electrodes 135, or therapy electrodes 140.

External defibrillator 115 can be included as part of wearabletherapeutic device 100. For example, external defibrillator 115 can beincluded in garment 105, pocket 160, attached to strap 145, or disposedin belt 110. In one embodiment, external defibrillator 115 iselectrically coupled to therapy electrode 140. Wearable therapeuticdevice 100 may include at least one receptacle having a conductive fluidencapsulated therein and housed in garment 105. For example, thereceptacle can be disposed in belt 110 or strap 145, proximate to atleast one of sensing electrode 135 and therapy electrode 140. In oneembodiment, electrodes 135 and 140 are dry electrodes. Control unit 130can release the conductive fluid from the receptacles to enhance anelectrical connection between sensing electrode 135 or therapy electrode140 and a subject wearing wearable therapeutic device 100 to, forexample, sense electrocardiograph information about the subject or toapply treatment to the subject. The receptacles can be replaced aftertheir conductive fluid has been released, or upon their expiration. Whena shock is applied, therapy electrodes 140, the subject's body, andexternal defibrillator 115 form at least part of a current path. Oneembodiment includes at least one sensing electrode 135, one therapyelectrode 140 disposed in front of the subject, e.g., proximate to thesubject's chest, and two therapy electrodes 140 disposed in back of thesubject, e.g. proximate to the subject's back.

Garment 105 can hold electrodes 135 and 140 in position, for exampleagainst the subject's skin around the subject's torso. Clothes or othermaterial may be present between garment 105 and the subject's skin. Whenpositioned against the subject, sensing electrodes 135 can senseelectrocardiogram signals used be control unit 130 to monitor thesubject's cardiac activity. When control unit 130 identifies anarrhythmia or other cardiac event, therapy electrodes 140, whenpositioned with a conductive surface facing the subject can deliverdefibrillating energy to the subject to convert the arrhythmia to anormal sinus rhythm.

In one embodiment, sensing electrodes 135 and therapy electrodes 140 aresecurely positioned facing the subject's body in order for sensingelectrodes 135 to sense cardiac, respiratory, or other information aboutthe subject; and for therapy electrodes 140 to apply treatment to thesubject. For example, sensing electrode 135 can includeelectrocardiogram electrodes that directly or indirectly (e.g., viaclothes, a conductive protective barrier, or a conductive fluid) contactthe subject's skin to sense an electrocardiogram signal with minimalartifacts. Further, a conductive surface of therapy electrode 140 candirectly or indirectly contact the subject's skin to reduce impedancebetween therapy electrode 140 and the subject's skin and to efficientlydeliver defibrillating energy to the subject, without causing burns,blisters, inflammation, or other damage to the subject's skin. In oneembodiment, conductive fluid is released from replaceable receptaclesthat are disposed in wearable therapeutic device 100 to contact thesubject's skin and surfaces of sensing electrode 135 or therapyelectrode 140 to reduce impedance and improve the quality of sensedelectrocardiogram signals.

In one embodiment wearable therapeutic device 100 includes at least oneconductive thread 150. Conductive thread 150 can include a metallic orother conductive material, such as a conductive wire that is configuredin a stitched (e.g., zig-zag) pattern. Conductive thread 150 can stretchor expand together with garment 105. Conductive thread 150 may be atleast partially shielded, jacketed, or insulated, and may includecontact surfaces that are broader than the rest of conductive thread 150and configured to contact conductive surfaces of sensing electrode 135or therapy electrode 140. Conductive thread 150 can connect to a powersupply of wearable therapeutic device 100 directly or via interveningelements such as conductive element 155 or wires. The power supply canalso be associated with external defibrillator 115, control unit 130,alarm module 120, or monitor 125.

Control unit 130 can detect open or closed circuits that includeconductive thread 150 and at least one of sensing electrode 135 andtherapy electrode 140 to determine that electrode 135 or 140 isimproperly positioned, e.g., facing away from the subject, or properlypositioned, e.g., facing toward the subject, (or the area the subjectoccupies when the subject is wearing wearable therapeutic device 100).For example, conductive thread 150 can be located in a lateral side ofpocket 160 distal from the subject. When a conductive surface ofelectrodes 135 or 140 contacts the conductive thread, that conductivesurface is facing away from the subject, and in this example isimproperly positioned to sense cardiac information or to apply therapy.Control unit 130 can detect this contact, for example by detectingcurrent due to the closed circuit formed by the contact, to determinethat electrode 135 or 140 is improperly positioned. In another example,conductive thread 150 can be located in a lateral side of pocket 160that is proximate to the subject. When a conductive surface ofelectrodes 135 or 140 contacts the conductive thread, that conductivesurface in this example is facing toward the subject, and properlypositioned to sense cardiac information or to apply therapy. Theformation of this circuit through which current may flow can beidentified by control unit 130 to determine that electrode 135 or 140 isproperly positioned.

In other examples, when conductive thread 150 is proximate to thesubject, e.g., in a lateral side of pocket 160 closest to the subject,an open circuit can indicate that electrodes 135 or 140 are absent orimproperly positioned with their conductive surfaces facing away fromthe subject. When conductive thread 150 is distal to the subject, e.g.,in a lateral side of pocket 160 furthest from the subject, an opencircuit can indicate that electrodes 135 or 140 are properly positionedwith conductive surfaces facing toward the subject, and away fromconductive thread 150 in this example.

In one embodiment, garment 105 or its components (e.g., belt 110 orstrap 145) include at least one pocket 160 to house at least oneelectrode (e.g., sensing electrode 135 or therapy electrode 140). Atleast one pocket 160 can also house control unit 130, externaldefibrillator 115, alarm module 120, monitor 125, and power supplies andother electronic equipment such as memory storage units. Pocket 160 canhave the form of a pouch, sleeve, slit, or flap with an opening on atleast one side for entry or removal of sensing electrode 135 or therapyelectrode 140. At least one button, snap, or zipper, can secure openingsof pocket 160 so that, for example, therapy electrode 140 does not fallout of pocket 160 due to subject movement. In one embodiment, theopening of pocket 160 is not secured by an additional element (e.g.,button, snap, hook and loop fastener, fastener, latch, or zipper) and isformed to accommodate sensing electrode 135 or therapy electrode 140.For example, at least part of pocket 160 can have elasticcharacteristics so that at least a portion expands to accommodate entryof sensing electrode 135 or therapy electrode 140, and contracts tosecure any electrode housed in pocket 160.

In one embodiment, pocket 160 has first and second lateral sides, seamsaround three edges, and a fourth edge open to accommodate entry andremoval of sensing electrode 135 or therapy electrode 140 into pocket160. The seams need not be continuous, and need not be stitched. Forexample, a series of buttons, hook and loop fasteners, zippers or snapscan attach the first and second lateral sides of pocket 160 to eachother. The seams can have openings to accommodate wires or otherelectrical components connected to sensing electrode 135 or therapyelectrode 140 and, for example, control unit 130.

In one embodiment, at least one of the first and second lateral sides ofpocket 160 is formed at least in part from a conductive mesh material.For example, the mesh material can be a conductive (e.g., metallic)fabric in a fine grid or mesh pattern included in the lateral side ofpocket 160 that is facing the subject. The mesh material can facilitatean electrical connection between sensing electrode 135 or therapyelectrode 140 and the subject's skin. In one embodiment, conductivethread 150 is included in at least one lateral side of pocket 160. Forexample, a first lateral side of pocket 160 that faces away from thesubject (when wearing wearable therapeutic device 100) can includeconductive thread 150, and a second lateral side that faces toward thesubject can include the conductive mesh material. Conductive thread 150can be included in both lateral sides of pocket 160. In one embodiment,control unit 130 detects electrical connections, (e.g., current) betweenconductive thread 150 and sensing electrode 135 or therapy electrode 140to determine proper or improper positioning of electrodes 135, 140.

In one embodiment, prior to sensing cardiac information or applyingtherapy, a conductive fluid is released from capsules proximate to themesh fabric. The capsules may be located in or proximate to pocket 160.The conductive fluid can cover at least part of the mesh fabric and thesubject's skin, and a conductive surface of sensing electrode 135 ortherapy electrode 140 to reduce impedance. This can reduce artifacts inthe signal from sensing electrode 135 and causes a more efficient andcomfortable application of therapy from therapy electrode 140.

In one embodiment, control unit 130 includes at least one processor asdescribed in commonly owned U.S. patent application Ser. No. 12/833,096,titled “System and Method for Conserving Power in a Medical Device,”filed on Jul. 9, 2010, which is incorporated by reference herein in itsentirety. The referenced application generally describes a processingarchitecture configured to conserve energy. Control unit 130 can monitora subject's condition and control wearable therapeutic device 100operations. For example, sensing electrode 135 can sense electricalactivity of the subject's heart signals. These signals can be displayedas an electrocardiograph on monitor 125. When an arrhythmic event orother form of cardiac distress is detected, alarm module 120 can providea warning that the subject wearing wearable therapeutic device 100 is indanger of, or is experiencing, for example, cardiac arrest. This warningmay be audio, visual, haptic (e.g., vibrating alarm module 120) orcombinations thereof. This and other information can be stored in memoryunits associated with control unit 130 for analysis by a doctor,rescuer, the subject, or a health care provider.

In one embodiment, alarm module 120 provides an alarm that indicatesthat the subject will receive an electric shock from externaldefibrillator 115 and at least one therapy electrode 140 when thesubject is wearing wearable therapeutic device 100, with therapyelectrode 140 disposed proximate to the subject's body. Treatment in theform of an electric shock can be applied to the subject wearing wearabletherapeutic device 100 unless the subject takes some action to preventexternal defibrillator 115 from applying the shock. For example, alarmmodule 120 or monitor 125 may include an interface having at least onebutton or touch screen. In this example, the subject can depress abutton. This indicates that the subject is conscious. In this example,the shock will not be applied while the subject depresses the button fora sufficient amount of time, or until control unit 130 determines thatthe electrical heart activity of the subject, detected for example bysensing electrode 135, has returned to normal. Continuing with thisexample, if the subject looses consciousness, the subject may releasethe buttons and external defibrillator 115 can apply a shock via atleast one therapy electrode 140.

Alarm module 120 can be part of monitor 125 or a separate element ofwearable therapeutic device 100. In one embodiment, alarm module 120alerts and instructs the subject to take corrective action to positionor reposition sensing electrode 135 or therapy electrode 140. In oneembodiment, alarm module 120 provides a notification that sensingelectrode 135 or therapy electrode 140 is improperly positioned. Forexample, an improperly positioned conductive surface of electrode 135 or140 can be facing away from the subject, (e.g., not facing towards ornot contacting the subject's skin so that information cannot be sensedor therapy cannot be applied) and can contact conductive thread 150.This improper positioning may be due to the subject, manufacturer, orhealth care provider accidentally inserting electrode 135 or 140backwards, with its conductive surface facing away from the subject; ordue to movement of the subject while wearing wearable therapeutic device100. The contact between conductive thread 150 and a conductive surfaceof sensing electrode 135 or therapy electrode 140 can complete or closean electrical circuit, causing current to follow a path that includesconductive thread 150 and a conductive surface of electrode 135 or 140.Control unit 130 can identify the closed circuit, which indicates animproperly positioned electrode 135 or 140, and instruct alarm module120 to notify the subject of the improper positioning.

Alarm module 120 can also provide a notification that sensing electrode135 or therapy electrode 140 is properly positioned. For example,conductive thread 150 can be located between the subject and aconductive surface of sensing electrode 135 or therapy electrode 140. Inthis example, contact between conductive thread 150 and electrode 135 or140 indicates that electrodes 135 or 140 are properly positioned, withtheir conductive surfaces facing toward the subject. Control unit 130can detect this contact and instruct alarm module 120 to notify thesubject of the proper electrode 135, 140 positioning.

Alarm module 120 can instruct the subject to tighten belt 110 toposition or reposition sensing electrode 135 or therapy electrode 140.This can reduce, for example, signal interference at sensing electrode135 by positioning this electrode proximate to the subject's skin, orproximate to a desired portion of the subject's body where a strongerelectrocardiogram signal can be sensed. This can also reduce impedancebetween therapy electrode 140 and the subject, or between a plurality oftherapy electrodes 140, allowing for more efficient and effectiveapplication of therapy to the subject.

Sensing electrode 135 and therapy electrode 140 can be temporary orpermanent components of wearable therapeutic device 100. Electrodes 135and 140 can be housed anywhere in garment 105. For example, at least onesensing electrode 135 can be integral to garment 105 and disposed inpocket 160 proximate to the subject's chest or abdomen when the subjectis wearing wearable therapeutic device 100. At least one therapyelectrode 140 can be integral to garment 105 and disposed in pocket 160proximate to the subject's back when the subject is wearing wearabletherapeutic device 100. Sensing electrode 135 and therapy electrode 140may include conductive surfaces such as a metal plate, foil, mesh,wires, thread, or conductive material in a generally circular, ovoid, orquadrilateral shape.

In one embodiment, sensing electrode 135 and therapy electrode 140include conductive material woven, sewn, or embroidered into wearabletreatment device 100. The conductive material can provide connectionsbetween any of electrodes 135 and 140, conductive thread 150, conductiveelement 155, and a battery powered external defibrillator 115. In oneembodiment, sensing electrode 135 senses the subject's electrocardiogramsignals and provides the sensed information to control unit 130 orexternal defibrillator 115.

The conductive material that may form at least part of sensing electrode135 and therapy electrode 140 can have various patterns to achieveproper electrocardiogram sensing and to administer therapy. In oneembodiment, sensing electrode 135 or therapy electrode 140 includes onlyconductive stitching. Sensing electrode 135 or therapy electrode 140 mayalso include conductive stitching that holds a metal foil or otherconductive component in place in garment 105, so that sensing electrode135 or therapy electrode 140 includes both conductive thread and aconductive foil.

The conductive material can be sewn into garment 105 (e.g., belt 110) ina zigzag pattern that can stretch as part of garment 105. Thisstretchable conductive stitching connects sensing electrode 135 andtherapy electrode 140 with control unit 130 or other garment 105components (e.g., external defibrillator 115) in the absence ofadditional wires. In one embodiment, the conductive material (e.g.,conductive wiring) can face toward or away from the subject's skin.

In one embodiment, garment 105 includes breathable fabric, or a materialthat wicks heat away from the subject's body. This can reduce heatbuildup between the subject's skin and sensing electrode 135 or therapyelectrode 140. Using conductive stitching for electrodes 135 or 140reduces heat buildup in one embodiment when electrodes 135 or 140 areformed from stitched conductive material in the absence of any furthermetallic or conductive foil. In one embodiment, sensing electrode 135 ortherapy electrode 140 are made of perforated conductive materials thatallow air flow proximate to the subject's skin. This air flow can drysweat or other fluid from the skin to avoid rashes and other skinproblems as a result of heat buildup and irritation.

Garment 105 can be adjusted to snugly fit the subject. For example,portions of garment 105 that include sensing electrode 135 and therapyelectrode 140 can be substantially flush against the subject, e.g.,electrodes 135 and 140 remain substantially in a fixed position againstthe subject when the subject is moving about as part of a daily routine,or undertaking moderate physical activity. Clothing may be presentbetween garment 105 and the subject. Alarm module 120 can alert thesubject when wearable therapeutic device 100 is not sufficiently tightand snug about the subject. For example, alarm module 120 can notify thesubject when the portion of garment 105 (e.g., pocket 160) that includessensing electrode 135 or therapy electrode 140 is not flush with orfairly tightly pressed against the patient in a substantially fixedposition.

Garment 105 or its components such as belt 110 or strap 145 can expandor stretch with time or repeated use, which can loosen the fit andpositioning of sensing electrode 135 and therapy electrode 140 proximateto the subject. Further, the subject's respiration will typically resultin periodic expansion of garment 105. Control unit 130 can detect thisexpansion and where appropriate, instruct the subject to repositionsensing electrode 135 or therapy electrode 140, for example bytightening garment 105.

Wearable therapeutic device 100 can include at least one conductiveelement 155, located for example in garment 105, belt 110, or strap 145.In one embodiment, conductive element 155 connects conductive thread 150with control unit 130. For example, conductive element 155 can be partof the circuit formed when conductive thread 150 and a conductivesurface of sensing electrode 135 or therapy electrode 140 makeelectrical contact with one another. In one embodiment, a connector suchas a snap or male-female connector makes the connection betweenconductive element 155 and conductive thread 150.

FIG. 2 is a schematic diagram depicting wearable therapeutic device 100in accordance with an embodiment. In the example of FIG. 2, garment 105includes two pockets 160 proximate to the back of subject 200. Each ofthese pockets 160 includes one therapy electrode 140. While not directlyillustrated in FIG. 2, pockets 160 can include conductive thread 150,for example sewn into the inner lateral side of pocket 160 nearest tosubject 200, or the outer lateral side of pocket 160, farthest fromsubject 200. Sensing electrode 135 is also disposed in pocket 160proximate to the chest of subject 200, in the general vicinity of theheart. Conductive element 155 connects control unit 130 with therapyelectrodes 140. Wearable therapeutic device 100 can include more thanone conductive element 155. For example, the same or a second conductiveelement 155 can connect control unit 130 with at least one sensingelectrode 135. Wearable therapeutic device 100 can include otherelements not illustrated in FIG. 2, such as power supplies, additionalelectrodes, and additional straps across the chest of subject 200 thatcan include conductive element 155. In one embodiment, at least onetherapy electrode 140 is located in a pocket 160 in front of subject200, proximate to the chest.

In one embodiment, control unit 130 determines the orientation ofsensing electrodes 135 or therapy electrodes 140 to determine if theyare properly positioned with a conductive surface of electrodes 135, 140facing toward subject 200 or improperly positioned with a conductivesurface of electrodes 135, 140 facing away from subject 200. Controlunit 130 can instruct alarm module 120 to provide a notification tosubject 200. The notification can instruct subject 200 to position orreposition sensing electrode 135 or therapy electrode 140. Thenotification can also indicate that an arrhythmic cardiac event has beendetected, based on information from sensing electrode 135, and provide awarning that therapy has been or will be applied within a time periodof, for example, a few seconds.

FIG. 3 depicts a portion of garment 105 where pocket 160 includesconductive thread 150 in accordance with an embodiment. With referenceto FIG. 3, conductive thread 150 can be sewn into the fabric of lateralside 305 of pocket 160. Lateral side 305 can be the interior lateralside of pocket 160 that faces inward toward the subject when the subjectis wearing wearable therapeutic device 100, or can be the exteriorlateral side of pocket 160 that faces outward away from the subject whenthe subject is wearing wearable therapeutic device 100. In oneembodiment, the second lateral side of pocket 160, not visible in FIG.3, includes a conductive mesh that lowers impedance of the electricalconnection between, for example, therapy electrode 140 and the subject.

In one embodiment, opening 310 of pocket 160 receives sensing electrode135 or therapy electrode 140. One or more flaps, buttons, snaps,fasteners, latches, hook and loop fasteners, or zippers may closeopening 310 when electrode 135 or 140 is disposed in pocket 160.Electrodes 135 or 140 can be removed from pocket 160 to be replaced,recharged, repaired, or repositioned. One or more connectors 315 such asconductive snaps 320 can couple conductive thread 150 with conductiveelement 155. Control unit 130 can receive as input information fromconductive element 155 to determine that conductive thread 150 is or isnot in contact with a conductive surface of electrode 135 or 140.

At least one therapy electrode 140 can be disposed in pocket 160, asdepicted in FIG. 3. Sensing electrodes 135 may also be disposed inpockets 160. In one embodiment, conductive surface 325 of therapyelectrode 140 contacts conductive thread 150 sewn into lateral side 305of pocket 160. Control unit 130 can determine that this contact has beenmade, for example by sensing current in conductive element 155, toidentify the direction in which conductive surface 325 is facing, e.g.,inward toward the subject or outward away from the subject. Control unit130 can then instruct therapy electrode 140 and defibrillator 115 toapply treatment (e.g., when therapy electrode 140 is properlypositioned) or to withhold treatment (e.g., when therapy electrode 140is improperly positioned). Control unit 130 with alarm module 120 ormonitor 125 can also notify the subject of proper of improperpositioning, or instruct the subject to reposition therapy electrode 140or garment 105.

FIG. 4 depicts a portion of garment 105 where pocket 160 includesconductive thread 150 in accordance with an embodiment. Conductivethread 150 can form various patterns in lateral side wall 305 of pocket160. For example, conductive thread 150 can be woven into the fabric ofpocket 160 to form a series of lines, each line substantially parallelto an edge of lateral side 305, with a conductive patch 405 disposed ineach of the four corners of lateral side 305. An additional conductivepatch 405 may be located substantially in the center of lateral side305, with conductive thread 150 connecting the central conductive patch405 with the rest of the pattern. Conductive patches 405 can includeconductive thread 150 around their edges, with central portion 410 beingmade of the same material as the rest of lateral side wall 305, orcentral portion 410 can include conductive material, such as a mesh,connected to conductive thread 150. One or more conductive elements 155can connect with conductive thread 150 at one or at a plurality ofdifferent points of conductive thread 150, such as at one or moreconductive patches 405, or at the corner areas of lateral side wall 305.In one embodiment, a plurality of conductive elements 155 connects witha plurality of conductive threads 150 at lateral side 305.

FIG. 5 depicts a portion of garment 105 where pocket 160 includesconductive thread 150 in accordance with an embodiment. Conductivethread 150 can be woven around the edges of lateral side 305 with aplurality of substantially parallel lines of conductive thread 150running diagonally across lateral side 305. The substantially parallellines may or may not be evenly spaced. Other configurations arepossible. For example, conductive thread 150 may form serpentine,circular, oval, quadrilateral, coiled, or triangular shapes on lateralside 305. In one embodiment, conductive thread 150 is woven into lateralside 305 sufficiently spaced so that conductive surface 325 contactsconductive thread 150 when sensing electrode 135 or therapy electrode140 is disposed in pocket 160 with conductive surface 325 facing lateralside 305. Conductive elements 155 can connect with conductive thread 150at multiple points of conductive thread 150.

FIG. 6 depicts a cross sectional view of garment 105 with therapyelectrode 140 disposed in pocket 160. Conductive surface 325 is facingtoward conductive mesh 605 and subject 200, away from conductive thread150, and in this example is properly positioned to apply treatment tosubject 200 because conductive surface 325 is in contact with subject200 via conductive mesh 605. Intervening elements such as conductivefluid or clothes can be present. Conductive thread 150 is woven intolateral side 305 of pocket 160 and not in electrical contact withconductive surface 325. In one embodiment, control unit 130 candetermine that therapy electrode 140 is properly positioned in pocket160 based on the absence of an electrical connection between conductivesurface 325 and conductive thread 150. In one embodiment, sensingelectrodes are disposed in pocket 160.

In one embodiment, sensing electrode 135 or therapy electrode 140includes a plurality of conductive surfaces 325. For example, ratherthan a single continuous conductive surface 325, therapy electrode 140can have two separate conductive surfaces 325 with an insulating ornon-conductive gap between them. In this example, a closed circuit formswhen conductive thread 150 bridges the gap and contacts each of the two(or other plurality) of conductive surfaces 325. Control unit 130 candetermine that therapy electrode 140 is improperly positioned in pocket160 based on the electrical connection between both conductive surfaces325 and conductive thread 150, or that therapy electrode 140 is properlypositioned in pocket 160 based on an absence of an electricalconnection.

FIG. 7 depicts a cross sectional view of garment 105 with therapyelectrode 140 disposed in pocket 160. Conductive surface 325 is facingtoward conductive thread 150, away from conductive mesh 605 and subject200, and in this example is improperly positioned to apply treatment tothe subject because conductive surface 325 is not directly or indirectlyin contact with subject 200. Conductive thread 150 is woven into lateralside 305 of pocket 160 and is in electrical contact with conductivesurface 325. In one embodiment, control unit 130 can detect thiselectrical connection and based on this connection determine thattherapy electrode 140 is improperly positioned in pocket 160. It shouldbe appreciated that the therapy electrode 140 could have a plurality ofconductive surfaces 325 separated by an insulating or non-conductivegap, with the presence of an electrical connection between theconductive surfaces 325 (due to the presence of the conductive thread)being indicative of improper positioning. In one embodiment, sensingelectrodes may also be disposed in a pocket similar to that of pocket160.

In one embodiment, surfaces of pocket 160 can include a pressure sensorsuch as a spring loaded sensor or piezoelectric sensor to detect contactwith conductive thread 150, as an alternative or complement toconductive surface 325. Sensing electrodes 135 and therapy electrodes140 can also include pressure sensors to detect contact with surfaces ofpocket 160. These pressure sensors can include conductive elements todetect electrical connections with garment 105 components such asconductive surface 325 or conductive thread 150. These pressure sensorscan also determine that garment 105 is properly fitted on the subjectwith the appropriate amount of tension to hold garment components suchas therapy electrodes 140 in position suitable to deliver treatment tothe subject.

FIG. 8 is a flowchart depicting a method 800 of facilitating care of asubject. In one embodiment, method 800 includes an act of providing awearable therapeutic device (ACT 805). In one embodiment, providing thewearable therapeutic device (ACT 805) includes providing a device thatincludes at least one electrode, such as a therapy electrode or sensingelectrode, and at least one length of conductive thread. The electrodemay be housed in a garment of the wearable therapeutic device, andproviding the wearable therapeutic device (ACT 805) may includeproviding a device with the conductive thread included in at least partof the garment, such as a lateral side of a pocket where the electrodeis included.

Providing the wearable therapeutic device (ACT 805) may also includeproviding a device having a control unit configured to identifyelectrical connections between conductive surfaces of electrodes andconductive thread, to determine, based on the identified connections orlack thereof, positioning of an electrode, and to notify the subject ofproper or improper electrode positioning. Providing the wearabletherapeutic device (ACT 805) may also include providing a device with analarm module coupled with a control unit to notify the subject ofevents, conditions, or information about the subject's condition orabout the condition of the wearable therapeutic device, includingpositioning of its components.

Method 800 can include an act of identifying an electrical connection(ACT 810). In one embodiment, this includes identifying an electricalconnection between a conductive surface of the therapy electrode and theconductive thread. For example, contact between the conductive surfaceand the conductive thread may form a circuit, and a control unit cansense current that follows a path between the conductive surface and theconductive thread to identify (ACT 810) an electrical connection betweenthese components. Other elements can be included in the circuit, such asa conductive element, e.g., a wire that connects the conductive threadwith, for example, a power supply or control unit.

Method 800 can include an act of determining electrode positioning (ACT815). In one embodiment, determining electrode positioning (ACT 815) isbased on the identified electrical connection (ACT 810). For example,when the conductive thread is woven into a lateral side pocket distalfrom a subject, or distal from the area that a subject occupies when thesubject is wearing the device, electrode positioning can be determined(ACT 815) to be improperly facing away from the subject when anelectrical connection is identified (ACT 810).

In one embodiment, electrode positioning can be determined (ACT 815) tobe proper when an electrical connection is not identified (ACT 810). Forexample, an open circuit can be detected, the open circuit including atleast portions of the conductive surface of the electrode and theconductive thread. When the conductive thread is located between thesubject and the conductive surface of the electrode, the electrode canbe determined (ACT 815) to be properly positioned when there is contactbetween the conductive surface of the electrode and the conductivethread.

Method 800 may include an act of providing a notification (ACT 820). Inone embodiment, an alarm module provides notification (ACT 820) that anelectrode is properly or improperly positioned. The notification may beprovided (ACT 820) audibly, visually, or haptically by an alarm moduleincluded in the wearable therapeutic device. The notification can beprovided (ACT 820) to the subject wearing the device or to a health careprovider remote from the subject via a network connection. In oneembodiment, providing the notification (ACT 820) includes providinginstructions to adjust positioning of an electrode. For example,notification can be provided (ACT 820) that an electrode is improperlypositioned in a pocket of the device, and the notification can includeinstructions to position the electrode with its conductive surfacefacing inward, toward the subject. In one embodiment, providing anotification (ACT 820) confirms proper placement of an electrode.Notification can also be provided indicating that a cardiac event orother information has been sensed by a sensing electrode, that therapywill be applied by a treatment electrode, or that therapy has beenapplied by a treatment electrode. In one embodiment, providing anotification (ACT 820) alerts bystanders or health care providers tostay away from and not touch the subject due to past application oftherapy (e.g., a defibrillation shock) or imminent future application oftherapy.

In one embodiment, method 800 includes an act of providing instructions(ACT 825). For example, providing instructions (ACT 825) can includeproviding instructions to operate the wearable therapeutic device, orproviding instructions on how to wear the wearable therapeutic device.In one embodiment, the instructions include instructions to the subjectregarding positioning of wearable therapeutic device components, such assensing or therapy electrodes. For example, due to an identified (ACT810) electrical connection between an electrode and conductive thread ofthe garment, instructions can be provided (ACT 825) to the subject toposition an electrode proximate to an area of the subject's body, suchas the center of the back, or proximate to the chest and heart of thesubject, so that the electrodes are positioned to provide therapy to thesubject or to sense cardiac or respiratory function of the subject.

Having now described some illustrative embodiments, it is apparent thatthe foregoing is illustrative and not limiting, having been presented byway of example. In particular, although many of the examples presentedherein involve specific combinations of method acts or system elements,it is understood that those acts and those elements may be combined inother ways to accomplish the same objectives. Acts, elements andfeatures discussed only in connection with one embodiment are notintended to be excluded from a similar role in other embodiments.

Note that in FIGS. 1 through 8, the enumerated items are shown asindividual elements. In actual implementations of the systems andmethods described herein, however, they may be inseparable components ofother electronic devices such as a digital computer. Thus, actionsdescribed above may be implemented at least in part in software that maybe embodied in an article of manufacture that includes a program storagemedium. In one embodiment, the program storage medium is non-transitory.The program storage medium includes data signals embodied in one or moreof a carrier wave, a computer disk (magnetic, or optical (e.g., CD orDVD, or both)), non-volatile memory, tape, a system memory, and acomputer hard drive.

From the foregoing, it is appreciated that embodiments of the wearabletherapeutic device described herein afford an effective way to verifyproper electrode positioning. The wearable therapeutic device accordingto various embodiments is able to determine electrode positioning basedon electrical connections between the electrode and conductive threadwoven into the garment so that information may be sensed accurately andso that therapy may be applied when appropriate. This increasesefficiency and effectiveness of the wearable therapeutic device.

Any references to front and back, left and right, top and bottom, innerand outer, toward and away, or upper and lower and the like are intendedfor convenience of description, not to limit the present systems andmethods or their components to any one positional or spatialorientation.

Any references to embodiments or elements or acts of the systems andmethods herein referred to in the singular may also embrace embodimentsincluding a plurality of these elements, and any references in plural toany embodiment or element or act herein may also embrace embodimentsincluding only a single element. References in the singular or pluralform are not intended to limit the presently disclosed systems ormethods, their components, acts, or elements to single or pluralconfigurations. References to any act or element being based on anyinformation, act or element may include embodiments where the act orelement is based at least in part on any information, act, or element.

Any embodiment disclosed herein may be combined with any otherembodiment, and references to “an embodiment,” “some embodiments,” “analternate embodiment,” “various embodiments,” “one embodiment” or thelike are not necessarily mutually exclusive and are intended to indicatethat a particular feature, structure, or characteristic described inconnection with the embodiment may be included in at least oneembodiment. Such terms as used herein are not necessarily all referringto the same embodiment. Any embodiment may be combined with any otherembodiment in any manner consistent with the aspects and embodimentsdisclosed herein.

References to “or” may be construed as inclusive so that any termsdescribed using “or” may indicate any of a single, more than one, andall of the described terms. Intervening embodiments, acts, or elementsare not essential unless recited as such.

Where technical features in the drawings, detailed description or anyclaim are followed by reference signs, the reference signs have beenincluded for the sole purpose of increasing the intelligibility of thedrawings, detailed description, and claims. Accordingly, neither thereference signs nor their absence have any limiting effect on the scopeof any claim elements.

One skilled in the art will realize the systems and methods describedherein may be embodied in other specific forms without departing fromthe characteristics thereof. For example, references to electrodesfacing toward or away from the subject include references to where thesubject would be positioned when wearing the wearable therapeuticdevice. Electrode positioning can be determined in the absence of thesubject wearing the device. Further, conductive thread, conductiveelements, electrodes, and other components can be at least partiallyinsulated, jacketed, or sleeved. Electrode positioning can be determinedto be proper or improper based on detection of electrical connections orthe absence of electrical connections. For example, either an electricalconnection indicating an outward facing electrode, or the absence of anelectrical connection indicating an inward facing electrode, canindicate an improperly positioned electrode. In some embodiments, anelectrical connection indicating an inward facing electrode, or theabsence of an electrical connection indicating an outward facingelectrode, can indicate a properly positioned electrode. The foregoingembodiments are illustrative rather than limiting. Scope of the systemsand methods described herein is thus indicated by the appended claims,rather than the foregoing description, and changes that come within themeaning and range of equivalency of the claims are embraced therein.

1. (canceled)
 2. A method of adjusting a fit of a wearable defibrillatorcomprising: monitoring an ECG signal of a patient for an arrhythmiacondition, the ECG signal being detected by a plurality of ECG sensingelectrodes, wherein the plurality of ECG sensing electrodes arepermanently integrated into a garment configured to be worn about atorso of the patient such that the plurality of ECG sensing electrodesare proximate to at least one of the patient's chest and abdomen whenthe garment is worn about the torso of the patient; detecting whether aportion of the garment that includes at least one of the plurality ofECG sensing electrodes or at least one of a plurality of therapyelectrodes configured to apply therapy to the torso of the patient isnot against the torso of the patient in a substantially fixed position;responsive to detecting that the portion of the garment is not againstthe torso of the patient in the substantially fixed position, causing,via an alarm module of the wearable defibrillator, a notification thatthe portion of the garment is not correctly in contact with the torso ofthe patient in the substantially fixed position; and causing a warningthat the therapy will be applied within a time period via the pluralityof therapy electrodes.
 3. The method of claim 2, further comprisingcausing the notification to be provided to the patient.
 4. The method ofclaim 2, further comprising causing the notification to be provided to ahealth care provider.
 5. The method of claim 4, wherein the notificationto the health care provider is provided via a network.
 6. The method ofclaim 2, further comprising providing a notification that the at leastone of the plurality of ECG electrodes or the at least one of theplurality of therapy electrodes is not properly positioned on thepatient.
 7. The method of claim 6, wherein the notification that the atleast one of the plurality of ECG electrodes or the at least one of theplurality of therapy electrodes is not properly positioned on thepatient comprises a notification that the at least one of the pluralityof therapy electrodes is not properly positioned on the patient.
 8. Themethod of claim 2, wherein causing the notification further comprisescausing a monitor of the wearable defibrillator to visually display anindication that the at least one of the plurality of therapy electrodesis improperly positioned.
 9. The method of claim 2, wherein thenotification further comprises an instruction to the patient to tightenthe garment.
 10. The method of claim 2, further comprising, in responseto a determination that at least one of the plurality of therapyelectrodes is improperly positioned, causing the at least one of theplurality of therapy electrodes to withhold the therapy from thepatient.
 11. The method of claim 2, further comprising one of audibly,visually, and haptically causing the provision of a notification thatthe at least one of the plurality of therapy electrodes is not properlypositioned on the patient.
 12. The method of claim 2, further comprisingcausing the alarm module to provide a warning that the patient is one ofin danger of experiencing cardiac arrest and experiencing cardiacarrest.
 13. The method of claim 2, further comprising applying aconductive fluid to enhance an electrical connection between the patientand the at least one of the plurality of therapy electrodes by releasingthe conductive fluid from at least one receptacle.
 14. The method ofclaim 2, wherein detecting whether the portion of the garment is againstthe torso of the patient in the substantially fixed position comprisesdetermining whether the at least one of the plurality of ECG sensingelectrodes is properly positioned with a conductive surface of the atleast one of the plurality of ECG sensing electrodes facing toward thepatient.
 15. The method of claim 2, wherein detecting whether theportion of the garment is against the torso of the patient in thesubstantially fixed position comprises determining whether the at leastone of the plurality of therapy electrodes is properly positioned with aconductive surface of the at least one of the plurality of therapyelectrodes facing toward the patient.
 16. A non-transitory computerreadable medium storing a sequence of instructions for adjusting a fitof a wearable defibrillator, including instructions configured toinstruct at least one processor of the wearable defibrillator to:monitor an ECG signal of a patient for an arrhythmia condition, the ECGsignal being detected by a plurality of ECG sensing electrodes, whereinthe plurality of ECG sensing electrodes are permanently integrated intoa garment configured to be worn about a torso of the patient such thatthe plurality of ECG sensing electrodes are proximate to at least one ofthe patient's chest and abdomen when the garment is worn about the torsoof the patient; detect whether a portion of the garment that includes atleast one of the plurality of ECG sensing electrodes or at least one ofa plurality of therapy electrodes configured to apply therapy to thetorso of the patient is not against the torso of the patient in asubstantially fixed position; responsive to detecting that the portionof the garment is not against the torso of the patient in thesubstantially fixed position, cause, via an alarm module of the wearabledefibrillator, a notification that the portion of the garment is notcorrectly in contact with the torso of the patient in the substantiallyfixed position; and cause a warning that the therapy will be appliedwithin a time period via the plurality of therapy electrodes.
 17. Thecomputer readable medium of claim 16, further comprising an instructionto instruct the at least one processor to cause the notification to beprovided to the patient.
 18. The computer readable medium of claim 17,further comprising an instruction to instruct the at least one processorto cause the notification to be provided to a health care provider. 19.The computer readable medium of claim 18, further comprising aninstruction to instruct the at least one processor to cause thenotification to the health care provider to be provided via a network.20. The computer readable medium of claim 16, further comprising aninstruction to instruct the at least one processor to provide anotification that the at least one of the plurality of ECG electrodes orthe at least one of the plurality of therapy electrodes is not properlypositioned on the patient.
 21. The computer readable medium of claim 20,wherein the notification that the at least one of the plurality of ECGelectrodes or the at least one of the plurality of therapy electrodes isnot properly positioned on the patient comprises a notification that theat least one of the plurality of therapy electrodes is not properlypositioned on the patient.
 22. The computer readable medium of claim 16,wherein the instruction configured to instruct the at least oneprocessor to cause the notification further comprises an instructionconfigured to instruct the at least one processor to cause a monitor ofthe wearable defibrillator to visually display an indication that the atleast one of the plurality of therapy electrodes is improperlypositioned.
 23. The computer readable medium of claim 16, wherein thenotification further comprises an instruction to the patient to tightenthe garment.
 24. The computer readable medium of claim 16, furthercomprising an instruction to instruct the at least one processor to, inresponse to a determination that at least one of the plurality oftherapy electrodes is improperly positioned, cause the at least one ofthe plurality of therapy electrodes to withhold the therapy from thepatient.
 25. The computer readable medium of claim 16, furthercomprising an instruction to instruct the at least one processor tocause the provision, one of audibly, visually, and haptically, of anotification that the at least one of the plurality of therapyelectrodes is not properly positioned on the patient.
 26. The computerreadable medium of claim 16, further comprising an instruction toinstruct the at least one processor to cause the alarm module to providea warning that the patient is one of in danger of experiencing cardiacarrest and experiencing cardiac arrest.
 27. The computer readable mediumof claim 16, further comprising an instruction to instruct the at leastone processor to cause at least one receptacle to release a conductivefluid to enhance an electrical connection between the patient and the atleast one of the plurality of therapy electrodes.
 28. The computerreadable medium of claim 16, wherein the instruction configured toinstruct the at least one processor to detect whether the portion of thegarment is against the torso of the patient in the substantially fixedposition further comprises an instruction configured to instruct the atleast one processor to determine whether the at least one of theplurality of ECG sensing electrodes is properly positioned with aconductive surface of the at least one of the plurality of ECG sensingelectrodes facing toward the patient.
 29. The computer readable mediumof claim 16, wherein the instruction configured to instruct the at leastone processor to detect whether the portion of the garment is againstthe torso of the patient in the substantially fixed position furthercomprises an instruction configured to instruct the at least oneprocessor to determine whether the at least one of the plurality oftherapy electrodes is properly positioned with a conductive surface ofthe at least one of the plurality of therapy electrodes facing towardthe patient.